The Gold Standard: Medication-Assisted Treatment (MAT)

The gold standard treatment for opioid use disorder (OUD) is called "medication-assisted treatment" (MAT). MAT combines FDA-approved medications and therapy to provide a "whole patient" approach to the treatment of OUD. 

There are three-FDA approved medications used for MAT: buprenorphine, methadone, and naltrexone. Each of these medications work in various ways to promote abstinence, decrease illicit drug use, prevent overdose deaths, and reduce criminal activity and disease transmission. increase social functioning and treatment retention. Buprenorphine and methadone as first-line treatments for OUD, similar to how insulin and aspirin are used as first-line treatments to diabetes and heart disease, respectively. 

There is a common misconception that abstinence and therapy-based rehab alone is adequate for treating OUD. Unfortunately, therapy alone cannot counteract the disruptive effects that OUD has on the brain—only medication can do that. Abstinence-based approaches also precipitate withdrawal, leaving opioid addicts vulnerable to cravings and environmental triggers. while simultaneously reducing the body's tolerance for opioids. The inadequacy of abstinence and therapy alone has led many prominent treatment centers to integrate medications like buprenorphine and naltrexone into their programs. 

Methadone: 
  • Full Opioid Agonist (Schedule II)
  • Satisfies cravings, reduces symptoms of physical withdrawal, prevents harms associated with illicit opioid use
  • May reduce the risk of overdose by heightening tolerance and reducing the desire to use illicit opioids with higher overdose potential
  • Comes in pill form, oral solution, or injection
  • Available solely through specially regulated opioid-treatment programs (OTP)
Buprenorphine:
  • Partial Opioid Agonist/Antagonist (Schedule III)
  • Binds to and fills opioid receptors, but only slightly activates them
  • Reduces cravings, diminishes symptoms of physical dependence and withdrawal, eliminates harms associated with illicit opioid use
  • Prevents overdoses directly by blocking effects of other opioids and by heightening one's tolerance for other opioids
  • Comes in a sublingual tablet or strip (combined with naltrexone), as a monthly injection, or in regular pill form
  • Available through OTP or physicians who have obtained a federal waiver
Naltrexone
  • Full opioid antagonist that binds to opioid receptors without activating them
  • May be used proactively to suppress cravings and block other opioids, or retroactively to flush opioids out of the body in the event of an overdose
  • Directly prevents overdoses by blocking other opioids from reaching opioid receptors (considered a "blocking" drug)
  • May be used proactively to suppress cravings and block the effect of other opioids, or retroactively to flush opioids out of the body during an overdose
  • Comes in pill form, injection, orintranasal spray
  • No regulatory constraints

There are two types of medications used in the treatment of OUD: opioid agonists and antagonists.

  • Opioid antagonists: bind to opioid receptors and shut them off, block effect of other opioids
  • Opioid agonists: bind to opioid receptors and activate them, mimicking other opioids but block their euphoric effect